Standing at the Crossroads

Kedrick Adkins stands at the intersection of healthcare as a local phenomenon and a national phenomenon; healthcare as a mission and a business; and even, to a certain extent, healthcare as an art and a science. Earning a bachelor’s degree in industrial and operations engineering, and an MBA in accounting and finance; working almost 31 years with a national consulting firm; and then joining a healthcare system that spans nine states, can have that effect on a person.

“We talk about healthcare being different [from other industries], and believe me, it is different,” he says. “But there are far more similarities, and a lot of the business issues are the same. In my work at Trinity, I’m taking some of the templates at how issues are solved in other industries and bringing them to healthcare.”

Adkins is president of integrated services for Trinity Health, the Novi, Mich.-based health system with 46 acute-care hospitals in nine states. He is responsible for financial services, treasury, information technology, supply chain management, procurement, and insurance and risk management. “I view these as infrastructure-type operations,” he says. “In effect, we have as customers the leadership at our hospitals.

“Even though we operate in different markets, and healthcare is local, these are functions where we really don’t need to be different from market to market.”

Lessons learned as a consultant
At consulting firm Accenture, Adkins worked in a variety of industries, including manufacturing, distribution, retail and government. He was considered one of the company’s pioneers and experts in the health insurance and managed care industries. His experience at Accenture included strategy development, technology planning, systems design, installation and process re-engineering for hospitals and health systems, physician-based organizations, national and international managed care companies, indemnity health insurers, numerous Blue Cross/Blue Shield plans and government health agencies.

Though he contemplated retirement, in 2006, he made the decision to join Trinity instead. “I thought this would be a terrific opportunity,” he says. “The people here are very committed to the work we do in Catholic healthcare. It’s a dynamic environment, and that made it very, very exciting.”

Given Adkins’s experience, the opportunity to bring him to Trinity was no doubt beneficial for the health system as well. “One of the lessons I learned [at Accenture] was the importance of, quite frankly, accountability, for driving outcomes and results,” he says. “I was in an environment where that was particularly important on a day-to-day basis. In order to be successful at that, certain techniques, characteristics and approaches to work become extremely important.

“Another thing I brought with me was focus. We are impacted by so many things; it’s easy to put too much on your plate. So focus becomes extremely valuable in almost any business.”

Unified Enterprise Ministry
Focus is critical to Trinity, spread out as it is from Michigan to California, comprising 379 outpatient facilities, 33 long-term-care facilities, and numerous home health offices and hospice programs, in addition to its acute-care facilities.

“We operate in regional clusters,” says Adkins. Some examples: Southeast Michigan, West Michigan, Columbus (Ohio), Boise (Idaho) and Silver Spring (Maryland). At the same time, though, the system identifies itself as a Unified Enterprise Ministry. Though it comprises 46 hospitals, “we like to operate as one,” says Adkins. “We have a common mission, vision and set of values. That’s the ‘unified’ part.

“Enterprise’ reflects the fact that we are a business ministry, if you will. We accept business risk as part of what we do.” Trinity employs more than 47,000 full-time staff, and reported $7 billion in unrestricted revenue in fiscal year 2009.

“At the same time, we are a ministry,” he says. “Part of our mission is to serve the underserved, in the spirit of Catholic healthcare.” Trinity spends around $400 million annually in its community benefit ministry. Its Institute for Health and Community Benefit maintains a focus on chronic disease prevention and management, eliminating disparities in health status or care delivery, understanding the care management and health delivery actions that work best to create healthy people, and effective data collection to achieve its goals. Its Equity in Care initiative strives to help Trinity deliver culturally and linguistically competent quality care to all patients.

Physician alignment
A key element of Trinity’s strategic vision is delivering seamless, integrated care, says Adkins. And that calls for a stronger, richer alignment with physicians. “We will do more to employ physicians and establish stronger networks that link primary care and our inpatient operations,” he says. By way of example, in October 2010, Saint Joseph Mercy Health System (a Trinity integrated health network in Ann Arbor, Mich.) merged with IHA, an Ann Arbor-based practice of 150 physicians and 40 nurse practitioners in 47 locations.

It’s true that hospital systems tried this 10 or 15 years ago, though many backtracked soon afterward. But today’s conditions are different, says Adkins. “I think a lot of what happened in the past was driven by the whole notion of managed care and capitation. We could get back to that, but I don’t think capitation is necessarily going to be a predominant method [of reimbursement]. Now, it’s more about aligned incentives and creating efficiencies.”

Teaming up with physicians makes more sense today than ever because of the nature of regulatory reform, and because of the fact that the federal government and other payers are seeking to bundle compensation for inpatient and outpatient care, says Adkins. “Physicians and hospitals will [receive] a single payment for an occasion of service, or a particular type of chronic illness, or even for a population,” he says.

The other driving force is the need for cost reduction in healthcare, he says. “As you look at cost reduction, one opportunity is to improve the efficiency of how the different network stakeholders work together. Not that that wasn’t an issue 15 or 20 years ago. But I think it’s more an issue today in terms of the importance of moving cost out of the system.

“The way we worked in the past – but hopefully not in the future – was fairly inefficient,” says Adkins. For example, penalizing hospitals for keeping patients too long, but rewarding physicians every time they visit a patient in the hospital, leads to misaligned incentives. “It’s one example of the predicament healthcare is in,” he says.

“By and large, when you think about hospital providers, it really is a ‘sick care’ system. Hospitals’ earnings come from [patient] volume.” But payers and employers – not to mention healthcare providers themselves – would like to keep people healthy. “We have to come up with constructs where we have aligned incentives.”

Continuity of care
Alignment with physicians should lead to another thing – continuity of care across the entire Trinity system. “We recognize that each patient situation is different,” says Adkins. “However, there are certain practices we’ve identified that can and probably should be implemented systemwide; they should be more the norm, recognizing there could be exceptions.”

Such continuity of care can’t occur without good data, and lots of it. “Through our technology, we have created a huge repository of clinical information,” he says. Trinity’s Genesis IT platform holds information on nearly 8 million patient encounters. “That’s a huge knowledge base for us. We’re able to draw on that digitized knowledge and identify protocols of care, and best practices that we think apply to certain illnesses and disease states and conditions.”

Healthcare reform
For some time prior to passage of the healthcare reform law in 2010, Trinity had lobbied for reform. Its “Find a Way” campaign called for universal coverage with uniform benefits, continuous protection and broad pooling for risk, and wellness promotion. At press time, some lawmakers were set to try to undo the law. But Adkins says that regardless of the outcome of that debate, many of the changes already precipitated by the law will move forward. In fact, the law only accelerated the pace of change that had already begun well before its passage.

“We had already initiated a lot of what we knew we had to do before the law was passed,” he says. In fact, Trinity Health has been transforming its own care delivery system for more than a decade. Some examples: Connecting the Ministry with a common electronic health record; practicing evidence-based care, for example, using data on falls and pressure ulcers to guide clinical decision-making; expanding access and extending care delivery to rural settings through the implementation of the electronic health record; and implementing innovative technologies, such as telemedicine, to ensure a prompt and effective pharmaceutical response in situations where there may or may not be a pharmacist present.

Supply chain’s role
Supply chain will no doubt be a big part of how Trinity moves forward post-healthcare-reform. It already is.

“One strategic initiative [Senior Vice President, Supply Chain and Capital Projects Management] Lou [Fierens] has promoted, with a great deal of success, is the clinically driven supply chain,” says Adkins. Tying together best practices and patient-care protocols with particular types of supplies and medication, Fierens has demonstrated that highest cost doesn’t always translate to the most effective solution, he says. In addition, Fierens has spent time with various specialists demonstrating the financial impact of some of their supply and equipment decisions on Trinity.

“Supply chain leadership really needs to help healthcare and hospital systems be far more data-driven, to make sure they are making the best decisions,” says Adkins. “Recognize that what gets physicians interested are facts and good data – data that’s been cleansed, and data that relates to their individual practices and cases. It’s not enough to go in and talk to them at a high level.

“[Supply chain leaders] need to be very, very good at helping to change behavior.”